Executive function is not what is holding back AUD treatment

The edition in brief

Today's psychiatry desk opens with a randomised placebo-controlled trial of intravenous esketamine in colorectal cancer surgery. Esketamine 0.5 mg/kg at induction plus 1 mg/kg in patient-controlled analgesia lowered both anxiety and depression subscales of the Hospital Anxiety and Depression Scale on postoperative days 1 and 3, reduced 24-hour interleukin-6 and raised satisfaction, all at P below 0.05; the report gives significance but no effect sizes and does not state how many patients were randomised. A four-week randomised trial of a smartphone ecological momentary intervention in 201 working adults found DASS-21 scores falling by 14.5 points in the intervention arm and rising by 3.3 in controls, with most of the movement in the stress subscale - but 21 of 102 intervention participants dropped out against 2 of 99 controls. A meta-analysis of 35 studies and 13,489 medical students puts the pooled prevalence of test anxiety at 49.8% (95% CI 39.9-59.6) with I-squared of 98.2%, highest in South-East Asia at 59.3%. A review of the gut-brain axis in inflammatory bowel disease sets out the neural, endocrine and immune pathways through which anxiety and depression appear to arise as secondary conditions rather than as reactions to chronic illness. The edition closes on a negative result: among 147 adults with moderate alcohol use disorder and low psychiatric comorbidity, performance on eight CANTAB tests of executive function was no worse than in a non-clinical reference sample, and no measure predicted reduction in drinking at 12 or 26 weeks. The impairment described in the literature belongs to the severe, highly comorbid end of the spectrum, not to the patients seen in most outpatient clinics.